DESCRIPTION: (Adapted from applicants abstract) The epidemiologic paradox presented by Hispanic health research in the U.S. shows a health outcome advantage for Hispanics, despite lower income and educational attainment. Health advantages often erode with increasing levels of acculturation. Nurses working with Mexican-origin children and their families to maximize child health outcomes need a culture-based conceptual model to relate the cultural context of child health production to household processes and child health outcomes. With eventual health care reform of some type a certainty, nurses need to support the cultural factors contributing to children's health, and minimize structural barriers to health care for Mexican-origin households. Given this background, the purpose of this focused ethnography is to describe the cultural context of child health production activities and processes for Mexican-origin children from birth through 19 months of age. This purpose will be attained through five specific aims. Aim 1 will describe household-based child health processes; Aims 2 and 3 will describe mothers' perceptions and expectations of professional and household-based child health care; Aim 4 will examine intra-cultural diversity in household health production and professional health care perceptions; and Aim 5 will provide narrative and graphic models of the household production of child health in cultural context. Attaining these aims will involve studying approximately 20-25 Mexican-origin households for 22 months each, from the prenatal period to the infant's 19th month. Home visits will be conducted prenatally (at 6 and 8 months of pregnancy), at birth, and when the infant is aged 1, 4, 7, 10, 13, 16 and 19 months. Unstructured ethnographic interviews will elicit data at home visits. Anthropometric data will also be collected on infants at home visits. Medical record data on infant health will provide additional health outcome information. Mothers in Phase 1 will take photographs for hermeneutic analysis. In Phase II, more focused sampling will begin. Focus groups will also be initiated on topics related to health production with members of mothers' social networks. Finally, participant observation will provide a larger cultural context for the data collection and interpretation. Data analysis will utilize mother's and health care providers' child illness narratives, interview discourse, focus group themes, and attend to the patterning of household health production and child health outcomes. In addition, a description of the sample (in terms of acculturation and socioeconomic status) will be provided. The results of this study will be available to researchers and clinicians seeking an integrated perspective on the cultural context of child health production in Mexican-origin households. Ultimately, the unique strengths of the Mexican American family and household described in this research may be supported and enhanced to facilitate optimal health outcomes for children.